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Acute Pancreatitis

Acute inflammation of pancreas
Digestion of pancreas by its own enzymes, mainly trypsin (enzyme needed for digestion, found in sm. intestine) can be mild to severe, mild inflammation to severe necrosis. Auto digestion of the pancreas.

Acute Pancreatitis-Etiology & Pathophysiology


Alcohol ingestion (common in men)
Biliary tract disease (more common in women)
Other causes
Any situation in which the pancreatic cells are injured can lead to pancreatitis
Trauma, viral infection, abscess/cysts, drugs: steroids, diuretics, NSAIDS (ibprofuen

Acute Pancreatitis-Clinical Manifestations

Severe mid epigastric pain radiating to back (retroperitoneal)
Pain described as piercing
Vomiting does not relieve pain
LUQ abdominal pain/tenderness, rigid abdomen
Increased temperature, increased pulse, decreased BP
Grey Turner sign - bluish discoloration in the flank area
Cullen sign - bluish discoloration in the umbilicus
*bleeding inside the area or retroperitoneal area
Clinical Manifestations (cont'd)
N/V -usually given antiemetics d/t vomiting not relieving pain/nausea
Fever
Leukocytosis - increase in WBC( anything greater than 10,000
What would the bowel sounds be?
Hypoactive - less than 5 bowel sounds in a min
Normal is 5-35 in a min

Complications

Pancreatic pseudocyst - cavity surrounding the pancreas is filed with necrotic products. A cyst forms outside. Has ABD pain, might feel a mass - may need drained (surgeon). Can lead to perforation leading to - Peritonitis: fatal, need very high doses of ATB to get rid of the infection.
Pancreatic abscess - may need drained. Mass filled with fluid within the pancreas
Mild to severe (necrotizing) pancreatitis
Pulmonary complications - pneumonia, atelectasis (collapse of the lung), pleural effusion (abnormal amount of fluid within the pleural space around the lung)
Cardiac complications - hypotension leading to shock
Tetany - muscle twitching decreased by calcium. Hypocalcemia - cramps, spasms.

Diagnostic Studies

Increased LABS
Amylase - digestive enzyme made primarily by the pancreas and salivary glands.
Lipase - digestive enzyme made primarily by the pancreas.
Glucose
CT Scan best imaging test
Normal Values
Plasma amylase: 70-200 U/L.
Plasma lipase: 7-58 U/L.
Urine amylase: Less than 1200 U/L.
Amylase creatinine clearance ratio: 1-4%.

Collaborative Care


NPO/NG tube to suction (decrease pancreatic secretions)
IV hydration( d/t dehydration, F&E imbalances) TPN if severe
Meds
Analgesics
Antacids, anticholinergics, proton pump inhibitors
Blood glucose monitoring
Insulin coverage if needed

Nursing Management

Assist with positioning of comfort - usually on their side, head slightly elevated
Teach about diet
What type of foods/drinks should be avoided?
No alcohol
Avoid high fat foods
Caffeine
Monitor for S/S hypocalcemia
Normal Calcium level 8.5 to 10.3
What are neuromuscular signs of calcium?
Numbness around lips, fingers
Tetany, twitching, spams
Trousseau's sign - b/p cuff reaction
Chvostek's sign - tap facial nerve near in front of ear lobe or corner of mouth. Should spasm facial muscles.

Chronic Pancreatitis

Progressive, continuous inflammation & destruction of pancreas
Pancreas replaced with fibrotic tissue (scar tissue)
Can be obstructive or non-obstructive

Etiology & Pathophysiology: Chronic Pancreatitis

Long-term alcohol use (80% of the time)
Other
Biliary disease
Cancer

Clinical Manifestations
Chronic Pancreatitis

Recurrent attacks of burning or gnawing abdominal pain- LUQ
Steatorrhea - pale color
Diarrhea
*malodorous - bad smell
Weight loss - fat is being excreted and not absorbed
Jaundice with dark urine
S/S diabetes mellitus
Patient unable to absorb & digest nutrients from their GI tract

Diagnostic Studies- Chronic Pancreatitis


LABS
Elevated OR normal amylase & lipase
ERCP - Endoscopic retrograde cholangiopancreatography
Visualize pancreatic & common bile ducts
Imaging studies

Collaborative Care-Chronic pancreatitis


Supportive tx/chronic care
Relieve pain
NPO
IV fluids
Meds
Analgesics
Pancreatic enzymes - replacement therapy (take with every meal and snacks)

Nursing Management
Chronic pancreatitis

Monitor stools to determine effective enzyme replacement
Teach about diet
Monitor for S/S diabetes mellitus
3 P's polyphagia, polydipsia, polyuria

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